Summaries of health policy coverage from major news organizations

CALIFORNIA: TO SET UP PILOT PROJECT FOR CHILDREN

California HMOs and providers are preparing to design "capitated pilot programs for treating seriously ill children under Medicaid." MODERN HEALTHCARE reports that California law "mandates that managed care pilots must test how best to treat" the children. According to Susan Maddox, president and CEO of the Children's Hospital Association, California "has already turned down one pilot that would have cared for most of the 140,000 seriously ill Medi-Cal children through a consortium of children's hospitals, university hospitals and key providers." Until the results of the pilot project have been studied, chronically ill children in the state "will continue to be seen by the special providers that have been caring for them under the California Children's Services Program (CCS)." However, they will receive their primary care from a managed care plan. PILOTS PLEASE: The California Department of Health Services is expected to issue an RFP for the three-year pilot programs by mid-year. According to Dr. Marydee Gregory, chief of children's medical services at the state health department, the "state will approve only a handful of pilots." She said that the "major benefit" of the programs is expected to be improved coordination and accessibility of special-needs care. Edwin Benjamins, director of utilization and case management at L.A. Care, said that he believes managed care will "improve access to care for more children with serious illnesses." He said, "The process of educating the providers and the HMOs is going to help identify more of those children" (Kertesz, 2/17 issue).

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